Cardiomyopathy NCLEX questions

Chapter 36: Cardiomyopathy & Valvular Heart Disease Evolve Practice

Questions ScienceMedicineCardiology sierraakin Save Cardiomyopathy NCLEX questions 25 terms iliana26076Preview Cardiomyopathy (Pearson) 12 terms holly_brock5Preview Cardiology - Valvular Heart Disease...15 terms Shirven_Maclean Preview Nclex Q 32 terms kar The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant?

• Regurgitant murmur at the mitral valve area
• Point of maximal impulse palpable in fourth intercostal space
• Heart rate of 94 beats/min and capillary refill time of 2 seconds
• Respiratory rate of 18 breaths/min and heart rate of 90 beats/min

ANS: A

A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. All the other findings are within normal limits.A 25-yr-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. How should the nurse respond?

• "You will not feel well if you do not take the medicine and get over this infection."
• "Once you have been treated for a group A streptococcal infection, you will not get it again."
• "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease."
• "You may not want to take the antibiotics for this infection, but you will be sorry if you do not."

ANS: C

Rheumatic fever (RF) is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say. Patients may have reoccurring infection of group A streptococcus.

The patient with pericarditis is reporting chest pain. After assessment, which intervention should the nurse expect to implement to provide pain relief?

• Corticosteroids
• Morphine sulfate
• Proton pump inhibitor
• Nonsteroidal antiinflammatory drugs

ANS: D

Nonsteroidal antiinflammatory drugs (NSAIDs) control pain and inflammation. Corticosteroids are reserved for patients already taking corticosteroids for autoimmune conditions and those who do not respond to NSAIDs. Morphine is not necessary. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of gastrointestinal bleeding from the NSAIDs.A 72-yr-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question?

• Aspirin
• Oxygen
• Nitroglycerin
• Morphine sulfate

ANS: C

Aspirin, oxygen, nitroglycerin, and morphine sulfate are all used to treat acute chest pain suspected to be caused by myocardial ischemia.However, nitroglycerin should be used cautiously or avoided in patients with aortic stenosis as a significant reduction in blood pressure may occur. Chest pain can worsen because of a decrease in blood pressure.The nurse is teaching a community group about preventing rheumatic fever. What information should the nurse include?

• Prompt recognition and treatment of streptococcal pharyngitis
• Avoiding respiratory infections in children born with heart defects
• Completion of 4 to 6 weeks of antibiotic therapy for infective endocarditis
• Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis

ANS: A

The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever.An 80-yr-old patient with uncontrolled type 1 diabetes is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done?

• Aortic valve replacement
• Have a pacemaker inserted
• Open commissurotomy (valvulotomy) procedure
• Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

ANS: D

The PTBV procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes. Aortic valve replacement would probably not be tolerated well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Open commissurotomy procedure is used for mitral stenosis. The patient is not a candidate for a pacemaker.

A 55-yr-old female patient develops acute pericarditis after a myocardial infarction. Which assessment finding indicates a possible complication?

• Presence of a pericardial friction rub
• Distant and muffled apical heart sounds
• Increased chest pain with deep breathing
• Decreased blood pressure with tachycardia

ANS: D

Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure. The other symptoms are consistent with acute pericarditis.Which patients are most at risk for developing endocarditis? (Select all that apply.)

• Older woman with histoplasmosis
• Man with reports of chest pain and dyspnea
• Man who is homeless with history of IV drug use
• Patient with end-stage renal disease on peritoneal dialysis
• Adolescent with exertional palpitations and clubbing of fingers
• Female with peripheral intravenous site for medication administration

ANS: C, D

Intravenous drug use, especially if reusing or sharing needles are at risk of developing sepsis. In addition, risk for infection is increased in the elderly, homeless, and those with chronic illness. Peritoneal dialysis requires strict sterile technique to prevent peritonitis. Chest pain, shortness of breath, and palpitations may be signs of endocarditis. Clubbing of the fingers indicates long-term hypoxia. Central venous catheters, not peripheral, increase risk to for infective endocarditis. Patients with fungal infections, such as histoplasmosis and candida, are at risk for pericarditis.The nurse provides discharge instructions for a 40-yr-old woman newly diagnosed with cardiomyopathy. Which statement indicates that further teaching is necessary?

• "I will avoid lifting heavy objects."
• "I can drink alcohol in moderation."
• "My family will need to take a CPR course."
• "I will reduce stress by learning guided imagery."

ANS: B

Patients with cardiomyopathy should avoid alcohol consumption, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points.

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder?

• Pulsus paradoxus
• Prolonged PR intervals
• Widened pulse pressure
• Clubbing of the fingers

ANS: A

Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree AV block. Widened pulse pressure occurs with valvular heart disease and increased intracranial pressure. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations? (Select all that apply.)

• Osler's nodes
• Janeway's lesions
• Splinter hemorrhages
• Subcutaneous nodules
• Erythema marginatum lesions

ANS: A, B, C

Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.What should the nurse teach the patient who has had a valve replacement with a biologic valve?

• Long-term anticoagulation therapy
• Antibiotic prophylaxis for dental care
• Exercise plan to increase cardiac tolerance
• β-Adrenergic blockers to control palpitations

ANS: B

The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.